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Due to growth, we are adding a Business Analyst, Government Programs, Med-D to our team.
The Business Analyst provides business analysis support for development, implementation, and maintenance of all products within the Technical Operations Department. The Business Analyst interacts with key operating departments related to Technical Operations business development and operational compliance. The Business Analyst also understands the roles and responsibilities of the business area and how it fits within the entire corporation....
Due to growth, we are adding a Claims Adjudication Product Manager (CAPM) to our team.
The Claims Adjudication Product Manager (CAPM) is responsible for ensuring Med D, Medicaid, and Exchange claims are adjudicating per CMS regulations as well as specific client needs. The CAPM will collaborate with other Navitus teams to ensure that the appropriate software, procedures, and oversight monitoring are implemented and operational in support of an environment of continuous improvements with claims adjudication.
Due to growth, we are adding a Claims Quality Analyst to our team.
The Claims Quality Analyst is responsible for validating that Med D, Medicaid, and Exchange claims are adjudicating per State/CMS regulations as well as specific client needs.
Is this you? Find out more below!
Navitus Health Solutions is seeking a Analyst, IT Governance to join our team!
The Analyst, IT Governance is responsible for developing and maintaining IT policies, procedures, guidelines, and standards in alignment with ITIL best practices. This role will work directly with application developers, business users, internal IT, and third-party vendors to improve performance, processes, and the overall health of the data. This role will participate in the planning and implementation of policies and procedures to ensure the systems are running optimal and processes are consistent with company goals, industry best practices and...
Navitus Health Solutions is seeking a Project Manager, Implementation HP Strategic Clients (IPM) to join our team!
The Project Manager, Implementation HP Strategic Clients (IPM) will interface with health plans and strategic employer clients which may include a government program component to manage projects including transitioning clients to Navitus from their current PBM, implementing new services/programs, facilitating a change in vendor relations, i.e. TPA, disease management organization, etc. and more. This role is responsible for building early relationships with the clients so they learn to trust us and have confidence that their transition needs will be successfully met as seamlessly as possible. The IPM...
Are you a pharmacist with rebate strategy experience? If so, we are looking for you! Navitus Health Solutions is seeking a Director, Industry Relations & Contracting to join our team.
Reporting to the Sr. Director, Industry Relations, the Director, Industry Relations & Contracting is responsible for leading the team of Rebate Contractors to support the maintenance and enhancement of effective relationships with all pharmaceutical manufacturers (Pharma). This includes negotiating contracts with respect to rebates and discounts for formulary inclusion to...
Due to growth, we are adding a Manager, Market Conduct Exams to our team.
The Manager, Market Conduct Exams will act as the liaison for market conduct exams across the nation, using state rules and regulations, established procedures, and industry standards and best practices to complete the examinations on behalf of Navitus to state regulators. The role will take the lead in coordinating data and document responses with internal departments for audits/examinations; communication with regulators regarding requests and clarifications as needed; finalize responses with the...
Due to growth, we are adding headcount! Our Principal, Business and Regulatory Strategy will be the liaison between legal and our provider services team using superior knowledge of PBM regulatory requirements to align them with our payables and reimbursement strategies.
The Principal, Business and Regulatory Strategy is for driving business solutions and readiness that aligns with regulatory transformation and requirements. Acting as a connective tissue between...
Due to growth, we are adding a Advisor, Industry Standards to our team!
The Advisor, Industry Standards is responsible for compliant implementation and oversight of the National Council of Prescription Drug Programs (NCPDP) Standards. This includes facilitating internal awareness of the impacts of NCPDP standard changes and their impact on the strategic vision for...
Lumicera Health Services is seeking a Pharmacist, Clinical Operations to join our Arizona team!
The Pharmacist, Clinical Operations will be responsible for performing telephonic consultations with patients regarding the use of their specialty medication and management of their disease state. They will perform medication reconciliation, screen for potential drug interactions, and provide side effect management recommendations. Another main duty of this role will include a high volume of product verification to ensure accuracy of orders prior to shipment. The Pharmacist, Clinical Operations can expect to interpret prescribers’ prescriptions,...
Due to growth, we are adding a Project Manager, Regulatory Implementation to our team!
The Project Manager, Regulatory Implementation is responsible for creating and executing project artifacts including project plans, communication plans, resource plans, and other tools used to guide teams in meeting project goals within defined scope and timelines. This role ensures the organization adheres to relevant laws, state regulations, and internal policies by assessing compliance risks, providing insightful guidance, and...
Due to growth, we are adding a Portfolio Value Manager, EPMO to our team!
The Portfolio Value Manager, EPMO is responsible for ensuring that enterprise initiatives deliver measurable business value across assigned portfolios. The Portfolio Value Manager partners with business and technology leaders to define, evaluate, and refine portfolio projects/epics and to provide transparency into value, benefits, dependencies, progress, barriers, and...
Navitus Health Solutions is seeking a Pharmacy Network Reporting Specialist to join our team!
The Reporting Specialist, Pharmacy Network will play a key role in supporting the analytical operations of the Provider Services department. The Specialist will be responsible for understanding business processes, the supporting data, and performing an array of analyses and report creations that...
Due to growth, we are adding a Senior Analyst, Network Contracting to join our team!
The Senior Analyst, Network Contracting will be responsible for the financial management of retail, specialty, and mail order pharmacy contracting, issue management, and reporting, in support of the network strategy to deliver value to Navitus clients. ...
Navitus Health Solutions is seeking a Network Contracting Analyst to join our team!
The Analyst, Network Contracting will be responsible for the financial management of retail, specialty, and mail order pharmacy contracting, issue management, and reporting, in support of the network strategy to deliver value to Navitus clients. The primary responsibilities of this role are to analyze current and new pharmacy contracts and provide support for all phases of the pharmacy contracting process, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business.
Due to growth, we are adding a Business Intelligence (BI) Developer to our team!
This is a hybrid role in Madison WI
The Business Intelligence (BI) Developer brings together theory and practice to identify and communicate data-driven insights that allow managers, stakeholders, and other executives in the organization to make informed decisions. The BI Developer will have an intermediate...
Due to growth, we are adding a Manager, Software Development to our team!
The Manager, Software Development role is directly accountable for the success of a designated Product Oriented Development (POD) team. A POD is a...
Lumicera Health Services is seeking a Prior Authorization Specialist I to join our team!
Under direction from the Supervisor, Specialty Pharmacy Services, and pharmacists in the Specialty Pharmacy, the Prior Authorization Specialist I is primarily responsible for obtaining information and assisting providers and insurance companies in triaging prior authorizations for patients of the specialty pharmacy. The Prior Authorization Specialist’s main objective is to answer phone calls and contact the doctors and patients via fax or phone or other communication means to facilitate and document prior authorization approval. The Prior...
The Data Engineer is responsible for designing, building, and maintaining scalable data pipelines and infrastructure that support enterprise analytics, reporting, and operational data flows. This role plays a critical part in enabling data-driven decision-making across Centene and SPM by ensuring the availability, integrity, and performance of data systems. The Data Engineer collaborates with data scientists, analysts, software developers, and business stakeholders to deliver robust ETL solutions, optimize data storage and retrieval, and implement secure, compliant data architectures in cloud and hybrid environments.
Operating within a healthcare-focused, compliance-heavy landscape, the Data Engineer ensures that data platforms...
The Data Engineer is responsible for designing, building, and maintaining scalable data pipelines and infrastructure that support enterprise analytics, reporting, and operational data flows. This role plays a critical part in enabling data-driven decision-making across Centene and SPM by ensuring the availability, integrity, and performance of data systems. The Data Engineer collaborates with data scientists, analysts, software developers, and business stakeholders to deliver robust ETL solutions, optimize data storage and retrieval, and implement secure, compliant data architectures in cloud and hybrid environments.
Operating within a healthcare-focused, compliance-heavy landscape, the Data Engineer ensures that data platforms...
Navitus Health Solutions is seeking a Platform Engineering and FinOps Manager to join our team!
The Manager, Platform Engineering and FinOps leads a team focused on enabling secure, scalable, and cost-effective software delivery platforms. This role oversees platform engineering functions such as CI/CD pipelines, developer tooling, and container orchestration, observability, while also managing the cloud financial operations (FinOps) and software procurement functions. This role partners closely with the Infrastructure and Cloud Operations team to ensure alignment on tooling, architecture, platform reliability and cost governance.
The Manager,...
Are you interested in working Monday to Friday (NO WEEKENDS) in a clean, bright environment with heat, air conditioning and best-in-class health benefits?
Lumicera Health Services is seeking a Pharmacy Technician at our Madison Facility! This role works at our state-of-the-art warehouse and is not in person patient-facing.
The Product Account Manager will support a key account and product. In addition to supporting the client relationship, this role will lead product management and project manage operational projects for this product. The role will be responsible for managing any client requests for builds and any necessary drug lists and formularies.
The Product Account Manager will interact with the account, product, and clinical management teams. This role will be responsible for managing and implementing any client specific product specific requirements, such as a custom formulary
The Product Account Lead will support a key account and product. In addition to supporting the client relationship, this role will lead product management and project manage operational projects for this product. The role will be responsible for managing any client requests for builds and any necessary drug lists and formularies.
The Product Account Lead will interact with the account, product, and clinical management teams. This role will be responsible for managing and implementing any client specific product specific requirements, such as a custom formulary
Due to growth we are adding an Intake Specialist to our team!
Under direction from the Assoc. Manager, Patient Support Services and pharmacists in the Specialty Pharmacy, the Intake Specialist I is primarily responsible for enrolling new Specialty Pharmacy patients and ensuring that all pertinent patient information is contained within the record. Patient information shall include demographics, allergies, medication history, comorbidities, and payer information. The Intake Specialist I’s main objective is to place phone calls to new and existing patients, answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Intake Specialist I is also responsible...
Due to growth, we are adding a Patient Care Assistant to our team!
Under general direction of the Supervisor, Pharmacy Services the person employed in this Patient Care Assistant/ Customer Service position will assist with the Specialty Pharmacy programs. Primary responsibility is to effectively communicate with patients, physicians, pharmacists, and payers to assist in the fulfillment and patient care of specialty pharmacy...